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No,36
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13689 SW ALPINE VIEW
-- -
CERTIF ICA fF OF
CITY OF TIGARD OCCUPA11c'y
COMMUNITY DEVELOPMENT DEPARTMENT DATE IbSUED: 06/0,40/9L,
13125 SIN Hall Blvd.Tigard,Orogon 97223*6199 (503)639-4171
OF wunr. :NE-w
/ ,P[:. OF USE. . . :1w
')LLUPANCY GRP. o�u '
/xlUPAN[Y LUAUx�
�
�
�
vpma, | ii : PATH I
�
�
� ')WTI Lur: '--—- ---- ---'--- -
� A]*DW0]D HOMES
| *0/6 5W 8ENCHVlEW T�RP |
� |
� | lGAND OR 9722*
� '/`"ne O* 590 -4700
�
�
�
� //JWbWUiD HOMES
� */6 SW BENCHVIE.W 7ERHA[E
�
�
� ' /.*ARD OR 9/�24
�
!his Lertificinte tpants ot'rupancy of the Above reff-P,iupcl building or- pot-tion
|
CITY OF TIGARD RCSTRICTED C:Nr'R(3Y
COMMUNITY DEVELOPME�:T DEPARTMENT PLRMIT #: ELR76--0093
13125 SW Hall Blvd.Tigard,Oregon 07223.8100 (503)839.4171 DATE 1 5 SUED: 03/15/96
PARCEL: 2SIOI)DA—N>:2 3
TL FIr,DC?r_r3�. . . : 136f3h CW ALPINE VIEW
LIBU I V 1,I ON. . . ,. : ZONING:
"LOCK. . . . . .. . . . . . LOT. . . . . . . . . . . . . .
"'r•a,ject Dpscr�iption: All res7idential
1, rC"aIDENT IAI _.. ._..._.._.._ S.
AUDIO & STEREO. . . : X FIUD (O & STEREO. . : INTERCOM & PAGING. . s
LAURGLAR Al....ARM. . . . : X DO1L..C:R. . . . . . . . . . . i._.AI�IDaf:Al-'C i II�RIGA'I'. . a
GARAGE. OPENER. . . . : X CLOCII.. . . . . . . . . . . . MEi,:1*7AL. . . . . . . . . . . . .
I I'JAC. . . . . . . . . . . . . : X [.TATA;TELE C:OMM. . . NURSE CALLS. . . . . . . ,
VACUUM OYSTEM. . . . :X FIRE ALARM. . . . . . . 0UTi1CJR LANDSC LITE.
OTHER. : : I IVAC. . . . . . . . . . . . c PROTECTIVE a I GNAT.... .
IN5TRUMENTATION. : OTHER. . : . .
TOT(IL # ;Jr SYSTE=M,:
Applic- Ant :
rE. :
41NDWOOD HOME.G type amolont by date r-ecpt
14076 ,W 13r'NCIIVICW TrCR —,k'MT 1 '4,r. ",)0 JSD ')6 =77la,(i;:
5P'CT $ x'. 00. JISD I7.131/15/96 96 x'77046
rIGAR1) 0R 972w.4
iclrie ##. rho 4700
ATNDWOOD CONSTRUCTION, INC„ t 4.:--. 00 TOTAL
19:33 SW TIE:RRA DEL MAR
REQU I REE INSPECTIONS
rkC0 VCRTON OR 9701017 Ceiling Caver- f=leet' 1 Fir-_:.[
't one #1: 780--4375) M Wall Cavev-
-1106
this permit is issued sub.'rc:'lc the rrenalations cont5ined in the
Tigard Municipal Cone, .ca.e of Ore. _r.::ialty rr;sa drd all other Perm e 7 i gnat LIr e
applicable laws, All cork will be done in ac-.crdance with _J
approved Flans. This perle t will eKpir; if dirk is not started --
within 180 days of issu ce, or i` work is suspended for eore
than 180 days. ICS s'.IF,d Dy
_ ..OW117-P 11<1 TAL_LAT I ON ONLY - - -- _
he it =;tarl l=tt ICTi is being made an prrpet-ty I awn which i <. r - '
'; Te' l ear e, or rent-.
JWI4ERI S 51 GNATURE: _ DAT L.
_ __... ...-... _.. ..._._...._ . CONTRACTr-P INSTf11_.L.ATI0N ONLY------- - _.___._.__._...._ __..._. ...__.._._
al.IJAORIZED SIGNATUR!7_: __...� _ DOJE: :
r_r-Nf:-E Nth" _.r.r._�� - - ...�......_�.-.. -.._ ._._.�.._..�_._v._._..._._._...
Call fc)i• inspection --- 639--4175
e
Community Developfrent RESTRICTED ENERGY ELE TRICAL APPLICATION
13125 SW Hall Blvd _ ��9
Tigard,OR 972?� PERMIT# /
Phone(503)639-4171 �. / �6
FAX (503) 684-7297 DATE ISSUED
TDD No. (503)684-2772
CITY OF TI Inspection (503)639-4175 ISSUED BY —�
PLEASE COMPLETE ALL SECTIONS
1. LOCATION JF INSTALLATION 4. TYPE OF WORK
Address RESIDENTIAL—Restricted Energy Fee. . . . . . . . . S�II0
T-" G-as d (� �� 27 Z 7 y (FOR ALL SYSTEMS)
City State Zip Check Tyne of Work Involved:
PERMITS ARE NON-TRANSFFRARLE AND NON-REFUNDABLE AND EXPIRE If WORK Audio and Stereo Systems
IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDFD FOR
180 DAYS. Burglar Alat m
2. CONTRACTOR APPLICATION Garage Door Opener*
Heating,Ventilation and Air Conditioning System'
Contractor vv11vQw0W I+JYwg Type-9 4 Lid tr AeAA.1('1p Vacuum Systems*
Address 1r07L 1wQc.�c.�W�t�,� 1 tr�,�� ❑ Other____
DateS _ COMMERCIAL—Fee for each system . . . . . . . . . 140.00� �, � (SEE OAR 918-260-260)
Property Owner�, wouc� �o >fr �r^_l _ Check Tyne of Work Involved•
Contractor's Board Reg. No. _ ❑ Audio and Stereo Systems
Phone# 5 90 -YElBoiler Controls
_ 70v Z7 S o-y�75 ❑ Clock Systems
3. OWNER APPLICATION ❑ Data Telecommunication Installations
❑ Fire Alarm Installation
— 11 HVAC
Print Owner's Name Phone No ❑ Instrumentation
Address ❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
City State tip ❑ Medical
This permit is issued under OAR 918.320.370.This applicant agrees to make only ❑ Nurse Calls
restricted energy installations(100 volt amps cr less)under this permit and to do the
foll,ming: 11Outdoor Landscape lighting'
1 Only use electrical licensed persons to do installations where required.(Certain n Protective Signaling
residential and other transactions are exempt from licensing. these have ❑ Other
asterisks(•).All others need licensing). -- ---
2. (all for an inspection when all of the installations under this permit am ready
for inspection at 503-639-4175.
❑ Number of Systems
3 Purchase separate permits for all installations that are not ready for inspection —
when the inspector is out to inspect under this permit. •No licen:es are required. Licenses are required fix all other installations.
4 Assume responsibility for assuring that all corrections required by the inspector
are done,and
i Assume responsibility for calling for a final Inspection when all of the 5. FEES
corrections are completed. )
The person signing for this permit must be the applicant or a person a. Enter Fees $ Gf
authorized to bind the applicant. — –�
—�'�� • b. 5% Surcharge(.05 x total above) $ C
Signatur� _ — ✓7
Awe
vf � TOTAL g`�
Authority it other than applicant /
ENERGARCHP
C11Y' OFTIGAR®
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)639-4171
:11RPIV7510N. .
BUILUING
Lit LL.L.11tiC UNITS. 1. W.:.)EMPA 1 . 13
cl>,.,) iji 4N(jHlj,. BEDRM5; ` BA1 i-G': 3 GARAGF.. . . . . . . . . . . 5
A-- r D
LUNS1I f LErT. . ft I G HT.
LZ f t
.. . . . . . . f RE QUI
1.. 0 TO i C4L
i.1,9970 VDA R K I N6 ',PACES. .
,{rid'.
to 144Ci-T i—DW P IRE'.1 d11 P
rF-,AP,' . . . . . V:
WA rEF4 H F.:--P.I . . . . . . . . .
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SIE.WEP CONNECTION
CITY OF TIGARD P E R M 111, it P C H tl I T
5'_
COMMUNITY DEVELOPMENT DEPARTMENT Dr4TE I 'UEL; 013/ 1
13125 SW H&H Blvd.Tigard,Oregon 97223o6199 (503)639-4171 PIPRICEL:
rIDDRES` '6.13'3 SW ALP-,INE 1,;lEW
:,I. LADIVISION. . . . ZONING:
.__OT. . . . . . . . „ . . . . .
Y.;ri NUJ. . . . . . . . . . . VIXII'LiRE. UNITE. . .
'MI NEW DWELLING UNITS. . I
, y'P[_ OF U(GE. . . . . SF NO. OF BUILDINGS: 1
V
7 i-;LJ_ TYr E. . . . 31JSWR IMPER'' 1� A SuRrACE.
FEES
i,i!1,'DWOOD HOMES type -I 1110 1.kn t 1) d.:t e
0,`6 (3W BL'NCH V I EW TE RR PRMT E 2L-7.'00. 00 D 0a/15
.CyAF12: OR ]t-7_
51)Q) 4.700
`N*'1'FRAC. ,-OR NOT ON rILL
# : t 33. as T 0 T A L
.- REQUIRED INSPEC'FIL)INI,
This i5pplicont agrees to comply with all the rules and reguliticils
of the Unified Sewage Agency. The permit expires 180 days fro@
the date issued. The total aso4nt paid will be forfeited if the
pit-sit expires. The Agency does rot guarantee the accuracy of the
`V1 sewer laterals. if the sewer is W located at the measurement
given, the installer shall prospect 3 feet in all directions from
the di=tarct given. If not so located, the jnstai0.x11 purchase
3 "Tap ar,_ Side Sesser' Permit and the Agency "I'l a late?&it
1 1.4 T
C.a
1 1 fur ins 1?L't 1 On G_39-41 5
93(o
Residential Building Permit Appligation
City of Tigard
13925 SW Hall Blvd.
Tigard, OR 97223
(5133) 639-4171
Jobsite Address: w w V t
�.
Subdivision: IZI LOt office Use Onljay
Contact
Valuation: � ��47�� _ ` Date Initials
/
`__
Result
PlanckfRec # SH _
Permit#
New Construction pifal�t :(6quarie footage) --
House Reissue of .
Map & TL# -��.._' `07 3
lone _
Corner Lot? Y � ) Flag Lot? Y (� Plat#
// '' ,, //,,,�'� �►pkroil
as Rpolfir
Owner: W 1�,1.� Udni c�5 4d --,
Plattr►ing 5etbaci<g�i F Solsa�'
Address: y—�4��/ ,S •� Gl�� fr- ;Wneering
er
Phone: Items Repu(red
Subcontractors
Contractor: _ _��,�_v _ Tluss Details
Address Other �.
Notes
Phone
Contractor's License
(attar �1J c of rmn' QMgon license)
Contact Name -t- S - --
Contact Phone: /
Subcontmetors: ArchiteeVEngineer: /� /C.(C �Cl��/r
Plumbing \,//Y" / )� Address: rc) /-).X
Med, finical: 44( �rc/ _ l_
(attach copy of current OR Contractors License)
►'hone
JOB DESCRIPTION
Applic g a Applicant Phone number
Received by* ""`^ 'f'�� _ Date Received: "��r���
H Ysy.•.eM, T
pert,�t 0 Account Descripdon Amount Amt Pd. Bal. Uue.
Bldg. Permit (FIuILD) -
Plumb. Permit (PLUMB) � _ 21.5-
_ Meeh. Permit (MECH)
State Taut (T,
Bldg: ..1
Plumh:
Meat: "L
Plan Check (PLANCK)
Bldg: �, 4
Plumb:
Mach:
Sewer Connection (SNVUSA)
Sewer Inspecoicn (SWINSP)
Parks Dev Charge (PKSD(:;
Residential TIF f i.F-R) �� V 0
Mass Transit TIF (TIF-Kr) Jt
Commercial TIF MF-C) —
Industrial TIF MF4)
Institutional TIF (TIF4S) _
Office TIF (TIF-0)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Lite Safety (r'LS) Q—�/--
Erosion Cntri Permit (ERPRMT) _ _ —a 0—`—
Erosion Planck/USA (ERPLAN) G� - '6, 0
Erosion Planck/COT (EROSN) Ld `� 60 r
TOTALS: --
Solar Bal
� ' nce- Point Standard
a
Box A. North-South dimension for the lot Box B. Shade point height from your structure:
measured perpendicular to the midpoint of the change in elevation from front property line to
north lot line the finished floor elevarion added to the height
of the building from finished floor elevation to
nthe affected peak/save. If the roof line runs
_" feet NIS, subtract 3 feet from the figure. Subtract
one toot for each foot of difference in elevation
from the front property line to the rear property
line. t
7 feet
Box C. Distance to the shade reduction line
Dist:.nce from North property line to
foundation added to the distance from the
foundation to the 77teetrpof peak/eave.
Feet
The following helps explain the graph below:
The horizontal axis (rows) represents box "C" figures.
The vertical axis (columns) represents box "A" figures.
It is most useful to draw a vertical line to represent the appropriate figure
found in box "A" and a horizontal line to represent the appropriate figure found
in box "C" . The intersection of the vertical and horizontal lines determines the
value found in box The value in box "D" should be compared to the value in
box "B" ; if the val in bo;: "B" is less than or equal to the value found in box
"D" , the building i in compliance with the solar balance code.
Distance to
shade 100+ 95 90 85 80 75 70 65 60 55 50 45 40
reduction line
from northern
lot line in feet
70 0 40 40_41 42 43 _ 44
65 3 38 38 39 40 41 42 43
60 3 36 36 37 38 39 40 41 42
55 3 34 34 35 36 37 38 39 40 41
50 3 32 32 33 34 35 36 37 38 39 40 41 42
45 3 30 30 31 32 33 34 35 36 37 38 39 40
40 2 28 28 29 30 31 32 33 34 35 36 37 38
35 2 26 26 27 28 29 30 31 32 33 34 35 36
30 2 24 24 25 26 27 28 29 30 31 32 33 34
25 2 22 22 23 24 25 26 27 28 29 30 31 32
20 2 20 20 21 22 23 24 25 26 27 28 29 30
15 1 18 18 19 20 21 22 23 24 25 26 27 28
10 1 16 16 17 18 19 20 21 22 23 24 25 26
5 14 14 14 15 16 17 18 19 20 21 22 23 24
Box "D" Maximum allo ed shade point height `'�' feet
Solar Balance Worksheet
Address
Box A calculations: North-South dimension for the lot. Box A:
This dimension is determined by finding the midpoint of the North lot line and drawing an
intersecting line perpendicular !o that point. Measure the distance from the midpoint of the
North lot line to
the South lot line along the described line. ft
Box B calculations: Shade point height from your structure. Box B:
1. Determine whether measurements will be based on the peak or save of your
structure. The orientation of the ridge is also important. Which describes
your lot?
1 a: If the roof line runs North-South, measurements will be based on the peak of the (Circle one)
roof.
la 1b1c C-
1 b:
'1b: If the roof line runs East-West wid the roof pitch is less than 5/12, measurements
will be based on the save.
1c: If the roof line runs East.-West and the roof pitch is 5/12 or steeper, measurements
will be based on the peak. ti
r ft
2. Pleasure change in elevation from front property line to finished floor elevation.
+ sft
3. Measure distance from finished floor elevation to the affected peakleave.
y_ ft
4. If the roof line runs North-South, deduct three feet. If the roof line runs East-West,
deduct nothing.
5. Subtract one foot for each foot of difference in elev^tion from the front property f1 ft
line to the rear property line, if the lot slopes up from the front to the rear. If the
lot has no slope or slopes up from the rear to the front, deduct nothing. _ _ _ _
6. Total figure for box B:
6 ft
111P minim=
Box C. Distance to the shade reduction line. Box C.
1. Measure the distance from the North property line to the foundation. ft
2. Measure the distance from the foundation to the affected peak or save. + ft
3. Total figure for box C:
� ft
.!: 1ogin7M 7zoisrcx
� U
SEE 35MM
ROLL# 22
FOS
L ARf�E
DOCUMENT
` Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Nall P�Ivd.
Tigard, OR 97 .Iv Planck/Rec. # -?s ;�7�5�1
Permit # ;/i u5" - O y�/7 _
J Phone (503) 639-4171 Date Issued lr� la -23
FAX (503) 684-7297 Issued byCl,! ,-,F I IGARD TDD No (503) 684-.-772
Inspection (503) 639-4175 _
1. Job Address: 4. Complete Fee Schedule Below:
Nanle of Development-----C, I , ' ,,/d Number of Inspections per permit allowed —
Address 3(o�L�lpl�l t�1st— �1 E H� ` rvlcF included Items Cost(ea) Sum
4a. Residential- per unit 4
City/State/Ziprl l�s�!/CUA n� ? �Zy 1000 a n or leaf $11000
Farb add-ur< 60( ea It Or .�
Name (or name of business) L()1NpiV,9O� Homes
portion then I $2500
Iim4eJ Energy $25 00
Commercial Ci Residential Each Manurd Home or Modular 1
Dwelling Service or Feeder we 00
2a. Contractor installation only: 4b.Services or Feeders
Lx;tallalinn,alleralion or re ocahon 2
Electrical Contractor �rJ7�f�/� ELCG f/�� G, / �1G. 200 amps or less $s0 00 2
— ---^v 201 amps to 400 amps $8000 2
Address. BuX 1�._ 401 amps m 600 amps $120 00 2
city_�o ���_ State 0& Zip f oZv 601 ampr.to 1000 amps $18000 _ a
Phone No.^�i�" /J'_ Over nett amps or volts $$50 00
— 7u—p� Reconnect only $5000
Contractor's License No._—__. �_1–�
Contractor's Board Reg. No._ _ Zo9� 4c.Temporary Services or Feeders
.� lnstallatirn alteration or relocalion
//�...��' 200 amps or less $5000 2
Signature of Supr. Elec' -- 201 amps to 400 amps $7500 2
license No. Z 34 _ Phone N W/,78-�3 401 amps to Boo amps $10000
()Ver 600 amps to 1000 Volts
?.b. For owner installations: gee"b atOVe
i 4d. Branch Circuits
Print Owner's Name_ �_ Now alteration or exlension per panel
Address '' a)The lee for branch circuits with
------ purchase or servlCl or)seder be.
City_ State___ zip -- Fach branch circuit $5 00
Phone No. b1 (he Ike for branch circuits without
purchase or service or Neder he.
The installation is being made on property i own which is Fust branchcurcud $3500
not intended for sale, lease or rent. each additional branch circuit $500
Owner's Signature �- _ 4e. MiscrAlonsous ?
(Servi^q or feedar not included)
Fach pump or irrigation circle $4000
2
3. Plan Review section (if required): Each sign or oulline lighting - $4000
Signal circuits)or a limited energy
Please check appropriate item and enter fee in section 58. panel.alteration or errtrnsion $4000
4 or more rE idenhal units in one structure Minor Labels(10) $10000
Service and feeder 22.5 amps or more 41. Each additional inspection over
System over 600 volts nominal the allowable in any of the above
Classified area or structure containing epactal occupancy I Per inspeclion $3S00
described scribed it N E C Chapter 5 per hour $5500
In Plant $5500
Submit 2 sets of plans with application where any of the above i
apply. Not required for temporer,const)fiction services. ` 5. Fees:
So. Enter total of above fees $ z3s o
NOTICE 5%Surcharge(05 X total fees) $
77-77
Subtotal $ 2.!
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 5b. Enter 25%of line A lot
AUTHORIZED IS NOT COMMENCLJ WITHIN 180 DAYS,OR IF Plan Review if required(Sec 3) $
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Subtotal $ � !-
A PERIOD OF 180 DAYS Ar ANY TIME AFTER WORK IS
COMMENCED ❑ Trust Account M $ )(
Balance Due $ y 6' 75
-- - -- ---- - -1
I PLUMBING PERMIT
CITY OF TIGARD PERMIT #. . . . . . . s PLM96-0,07
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 05/07/96
13125 SW ysd Blvd.Tigard,Oragoa• 97223*8190 1505)639.4171
PnRCELs 251098A-H5223
SITE ADDRESS. . . : 13689 SW ALPINE VIEW .
SUBDIVISION. . . . : HILLSHTRE: SUMMIT #2 ZONING: R-7 PD
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . ..023
CLASS OF� WORK. . :NEW GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0
TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 1
OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . : 0 TRAPS. . . . . . . . . . . . . . : 0
STORIES. . , . . . . . . c: WATER HEPTERS. . . . . . 0 CATCH BASINS. . . . . . . . 0
FIXTURES-------------- LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0
SI NKS. . . . . . . . . . . 0 URINALS. . . . . . . . . . . : 0 G PEASE TRAPS. . . . . . . : 0
LAVATORIES. . . . . : 0 OTHER FIXTURES. . . . : 0
TUB/SHOWERS. . . . : 0 SEWER LINE (ft) . . . : 0
WATER CLOSETS. . : 0 WATER LIME (ft ) . . . : 0
DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remarks: PA1H I
Owner: _..__--•.----__-------____-•---._.-•-.---_____.______._.__.____-_- FEES ---- ----------
WINDWOOD HOMES type amount by date ry=pt
14076 SW BENCHVIGW TE:RR PRMT t 15. 00 JDA 05/07/96 96-
5PCT f 0. 75 JDA 05/07/96 96--
TIGARD OR 97224
Phone *1 590-4700
Contractors __-__-.__.----------------_._.__-_
CEDAR LANDSCAPE
14076 SW PATRICIA
H'ILLSBORO OR 97123 --------------------------------------
Phone
_-------.---.-----------------------
Phone #: 503-628--3411 L 15. 75 TOTAL
Reg #. . s 5843
REUU I RED INSPECTIONS
---- -_
This permit is issued subject to the regulations contained in the RP/Backflow Prev
Tigard Municipal Code, State of Orr. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in acc5rdance with
approved plans. This permit will expire if work is not started
within 188 days of issuance, or if work is suspended for more _
than 180 days.
1 e r•m i t t e e Si gnat 11r1 e : _-_-a"w-- �----..-
_ --..--.__...___.-._..
Gall for- inspection - 639-4175
City of Tigard PLUMBING PERMIT APPLICA'T'ION Planck/Rec. #
13125 SW Hall Blvd. Permit #
Tigard, OR 97223
(503) 639-4171
MINIMUM $'-5.00 PERMIT FEE + ST. SURCHARGE
N.-of 0„w°m.m New Single Family Residences Only
nae.„ ❑ 1 BATH HOUSE$140.00 ❑ 2. BATH HOUSE$195.00
Jobi_��,��' j /1(/ /^�� y'/�(�/ l>h'ly ❑ 3 BATH HOUSE$225.00
Address a,(s(.(. za Fee includes all plumbing fixtures in the dwelling and the first 100 feet
C, 44 7 L)�� of water service, sanitary sewer and storm sevier. See fees below
N...(a n.m..(eu.n..n FIXTURES QTY PRICE AMT
Wti'v►1/d�'i? �L,� G Sink 9.00
MYny gee... Ph- Lavatory 9.00
Owner %•�bJ.Z /�/ /i �/C�/ Tub or Tub/Shower Comb. 9.00 _
ZIP Shower Only 9.00
Water Closet 9.00
N."im n.m..(tin l Dishwasher 9.00
ln,,i�b � �orctF� Garba(a Disposal 9.00
Occupanr M•e a,a, �«. Washing Machine 9.00
Floor Drain 9.00
�(m.(. - �• Water Heater 9.00
Laundry Room Tray 9.00
N.m. Urinal 9.00
Other Fixtures (Specafy) 9.00
Ming witty 900
Contractor
14j7)- S(/,r 15i1,'f./CY/� r�Dc- - _- 900
cer(stn. no 9.00
7 r
7/.;2 Sewer 1st 100' 3000
r•(.H.w°•( N• ca,eh. r.. Sewer -ea. Addit. 100' 25.00
Water Service 1st 100' 30.00
I hereby acknowledge that I have read this application, that the Water Serv;-e ea. Addit. 200' 25.00
information given is correct, that I am the owner or authorized agent of
the owner, that plans submitted are in compliance with State laws, that storm 8 Ra n Drain 1st 100' _ 30.00
I am registered with the Construction Contractor's Board, `.-t the Storm &Rain Drain Addit 100' 25.00
number given is correct. (If exempt from Slate regis; ation please
give reason below.) Mobile Home Space 25.00
Back Flow Prevention
Device or Anti-Pollution Device 9.00
.n.. �.�«a.°•nn D.t. Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work ne.v t;� addi'ion 0 alteration repair Catch Basin 9.00
to be done risidenJal (Y' non-residential 0 Insp. of Exist. Plumbing 40,001hr
Specially Requested Inspections 40.00/hr
Existing use of / Rain Drain, single family dwelling 30.00
building or property i`Y o/�sG _ -
Residential backflow prevention
devices 1500 /3
Proposed use of
building or propert/ -__ _
'(Except residential backflow
preven,ron devices)
NOTICE 'Minimum Fee 25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION �3
AUTHOFIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
PLAN REVIEW 25% OF SUBTOTa,
COMMENCED
3 7!
TOTAL
Snec!al Conditions
Date sued b, l
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service CFINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mach. Shear/Sheath Framing
Plbg.Und/Flr/Slab Plbg.Top Out Insulation c.
Post/Beam Struct. Mect. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other: --— --
Date: A.M. _ Entry:
Address: 1 33 y(a FS!? SC-L)
T ant: MST: _
Co Own: 1�d..KX.�d�----�� aU MEC: _—
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PLM-
_703 -
LM:-703 - Sy 55l ELC: _
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: — CF�
— �
Inspector: _- _- Date:[�,APPROVED DISAPPROVED/CALL FOR REINSP. CF CO